Penko Meta, Hojs Fabjan Tanja, Bevc Sebastjan, Kanič Vojko, Hojs Radovan
Department of Cardiology, Clinic for Inter nal Medicine, University Medical Center, Maribor, Slovenia.
Cardiol J. 2014;21(2):163-9. doi: 10.5603/CJ.a2013.0083. Epub 2013 Jun 25.
The aim of our prospective study was to define the impact of renal dysfunction on future cardiovascular events and total mortality in 390 patients suffering from ischemic stroke.
A quantitative measurement of neurologic deficit according to National Institutes of Health Stroke Scale (NIHSS) score was performed. Blood parameters were measured. Diabetes, hypertension and smoking habits were defined. Estimated glomerular filtration rate was calculated.
153 (39.2%) patients had renal dysfunction. In the follow-up period in 36 (9.2%) patients acute coronary syndrome, in 102 (26.2%) recurrent ischemic stroke and in 44 (11.3%) peripheral arterial disease were documented. 191 (49%) patient died, 118 (30.3%) of whom died of cardiovascular events. Patients who died were older, had higher prevalence of renal dysfunction and NIHSS score. The Kaplan-Meier survival analysis showed that total mortality (p < 0.003) and cardiovascular mortality (p < 0.01) were higher in patients with renal dysfunction. According to Cox's regression analysis, renal dysfunction was the predictor of cardiovascular events, cardiovascular and total mortality.
Patients with ischemic stroke and renal dysfunction are at higher risk for long term cardiovascular and total mortality. The patients with ischemic stroke and renal dysfunction are also at higher risk of new cardiovascular morbidity. Renal dysfunction should be added to the other known prognostic factors in patients with ischemic stroke. Our results also emphasize the importance of identification and management of renal dysfunction in stroke patients.
我们前瞻性研究的目的是确定肾功能不全对390例缺血性脑卒中患者未来心血管事件和总死亡率的影响。
根据美国国立卫生研究院卒中量表（NIHSS）评分对神经功能缺损进行定量测量。检测血液参数。明确糖尿病、高血压和吸烟习惯。计算估计肾小球滤过率。
153例（39.2%）患者存在肾功能不全。在随访期间，记录到36例（9.2%）患者发生急性冠状动脉综合征，102例（26.2%）患者发生复发性缺血性脑卒中，44例（11.3%）患者发生外周动脉疾病。191例（49%）患者死亡，其中118例（30.3%）死于心血管事件。死亡患者年龄更大，肾功能不全和NIHSS评分的患病率更高。Kaplan-Meier生存分析显示，肾功能不全患者的总死亡率（p<0.003）和心血管死亡率（p<0.01）更高。根据Cox回归分析，肾功能不全是心血管事件、心血管和总死亡率的预测因素。
缺血性脑卒中和肾功能不全患者长期心血管和总死亡率风险更高。缺血性脑卒中和肾功能不全患者发生新的心血管疾病的风险也更高。肾功能不全应添加到缺血性脑卒中患者其他已知的预后因素中。我们的结果还强调了识别和管理脑卒中患者肾功能不全的重要性。
